Views vary on ACL reconstruction

 

Discussing whether anterior cruciate ligament (ACL) reconstruction is necessary was the subject of two presentations at the APA WA branch evening event in late August. Held at the Wembley Golf Club, the event attracted more than 190 professionals including GPs, orthopaedic surgeons, sports and exercise physicians as well as physiotherapists.

The evening consisted of presentations from Dr Toby Leys, a consultant orthopaedic surgeon, and Kieran Richardson, a Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapy in 2016). Toby has an interest in all aspects of knee surgery, with a special interest in ACL injury management, and Kieran has a passion for non-operative management of ACL injury and has delivered workshops training physiotherapists across Australia on this topic for many years.

Both presenters agreed that there was an emerging cohort of patients that would benefit from a non-operative approach, and that structured exercise rehabilitation—or prehabilitation where appropriate— delivered by physiotherapists was integral to the successful management of these conditions. There was disagreement on the methodology of selection of patients to include in a non-surgical group, the significance of bedside ligamentous testing, and the methodology and interpretation of the KANON literature.

The presentations, as well as the following questions and answer session, were held in a respectful and collegial manner, and there was rich discussion after the event, with attendees and presenters staying back to share clinical stories and discuss management theories. Both presenters offered to present again on the same or similar topic, and were thankful the APA hosted an event which would progress the discussion and result in better quality of care for patients of all professions represented at the event.

Kieran says: ‘It was a pleasure to be a part of this APA event. There is no high-quality evidence showing the additional benefit of reconstruction and rehab to physiotherapy and exercise alone when managing ACL tears with or without concomitant injury. It is an exciting time for the physiotherapy community to be communicating this information within our profession, to patients, the general population and other professions.’

Toby says: ‘It was a pleasure to be invited to present at the APA event for this timely discussion on the management of ACL injury. There is evidence that in selected cases some people will have good outcomes without surgery. But the evidence also tells us that a non-selective approach to non-operative management results in increased instability and a significant increase in subsequent meniscal injury. A thorough assessment of the patient clinically and on MRI must be performed in all cases, and strict selection criteria followed in order to prevent these avoidable poor outcomes.’ Thanks go to event sponsors Skins and ASICS.

APA Acting Chief Executive Officer Anja Nikolic spoke on behalf of the national office and announced that the APA conference on business, education, leadership and practice, FOCUS 2020 (focus.physio), would be held in Perth next May.

 

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